摘要
目的:初步分析剖宫产术后瘢痕憩室(CSD)引发产后出血及对女性再次妊娠母婴结局等的潜在影响。方法:患者按照受试者是否为CSD孕妇将其分为CSD和非CSD组,采用队列研究的设计方案对所有受试者进行前瞻性观察,并随访至观察期结束(新生儿顺利娩出)。结果:CSD组的子宫下段肌层异常、宫缩乏力的发生率显著高于非CSD组,子宫下段肌层厚度显著低于非CSD组,两组患者间前置胎盘、盆腔粘连、产后出血和新生儿窒息的发生率及分娩孕周、术中出血量、新生儿体重和新生儿Apgar评分比较,差异无统计学意义(t=4.956、0.029、0.003、0.127、3.928、0.353、0.492、3.233,P>0.05)。子宫下段肌层异常的RR值为2.031,宫缩乏力的RR值为1.833,子宫下段肌层异常的AR值为0.508,宫缩乏力的AR值为0.454,另外,对母婴不良结局可能造成潜在影响的重要因素进行单因素回归分析,并且在此基础上分析不良母婴结局的相关影响因素,结果提示剖宫产术后瘢痕憩室的存在是一个独立的危险因素,其OR值为2.45,此外,年龄较高(>30岁)、距前一次妊娠时间短(<12个月)也均表现为危险因素,其OR值分别为1.28和1.23。结论:CSD对女性再次妊娠母婴结局的潜在影响主要表现在该暴露可导致子宫下段肌层异常及宫缩乏力。CSD的存在是引发再次妊娠母婴不良预后的独立危险因素,同时受孕妇高龄及与前次妊娠时间间隔过近等因素影响,值得临床关注并予以适当健康指导。
Objective:To preliminarily analyze the potential impact of postpartum hemorrhage caused by scar diverticulum(CSD)after cesarean section on the maternal and infant outcomes of re-pregnancy in women.Methods:The patients were divided into CSD group and non-CSD group according to whether the subjects were pregnant women with CSD.All subjects were prospectively observed using the cohort study design,and were followed up until the end of the observation period(the newborn was delivered successfully).Results:The incidence of abnormal lower uterine segment myometrial and uterine atony in the CSD group was significantly higher than that in the non-CSD group,and the thickness of the lower uterine segment myometrium was significantly lower than that in the non-CSD group.There were no statistically significant differences in the incidence of placenta previa,pelvic adhesions,postpartum hemorrhage,neonatal asphyxia,gestational age,intraoperative blood loss,neonatal weight,and neonatal Apgar score between the two groups(P>0.05).The RR value of lower myometrial abnormalities was 2.031,the RR value of uterine atony was 1.833,the AR value of lower myometrial abnormalities was 0.508,and the AR value of uterine atony was 0.454.In addition,univariate regression analysis was performed on important factors that may have potential influence on adverse maternal and infant outcomes,and on this basis,the related influencing factors of adverse maternal and infant outcomes were analyzed.The results suggested that the existence of scar di⁃verticulum after cesarean section was an independent risk factor,and its OR value was 2.45.Higher age(>30 years old)and short time from previous pregnancy(<12 months)were also risk factors.factor,the OR value were 1.28 and 1.23.Conclusion:The poten⁃tial impact of CSD on maternal and infant outcomes in re-pregnancy in women is mainly manifested in the exposure to lower uterine segment myometrial abnormalities and uterine atony.The existence of CSD is an independent risk factor for the poor prognosis of moth⁃er and child in another pregnancy.It is also affected by factors such as the advanced age of the pregnant woman and the close time in⁃terval from the previous pregnancy.It deserves clinical attention and appropriate health guidance.
作者
周仲元
ZHOU Zhong-yuan(Department of Obstetrics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,450000,China)
出处
《黑龙江医学》
2022年第3期269-271,共3页
Heilongjiang Medical Journal
关键词
剖宫产术后瘢痕憩室
再次妊娠
母婴结局
潜在影响
Cesarean scar diverticulum
Re-pregnancy
Maternal and infant outcomes
Potential impact
